以培美曲塞为基础的联合化疗方案治疗老年人晚期非鳞非小细胞肺癌的临床研究

Clinical study of pemetrexed-based chemotherapy in the treatment of elderly patients with advanced non-squamous non-small-cell lung cancer

目的 评估以培美曲塞为基础的联合化疗方案一线治疗老年晚期非鳞非小细胞肺癌（NSCLC）患者的临床效果和安全性。方法 回顾性分析经病理学确诊的老年晚期非鳞NSCLC患者40例，采用培美曲塞联合顺铂或卡铂方案全身化疗，其中培美曲塞联合顺铂组（A组）18例，培美曲塞联合卡铂组（B组）22例，根据实体瘤疗效评价标准（RECIST）和美国国家癌症研究所化疗毒性分级标准（NCI-CTC AE）对疗效和不良反应进行评估。结果 40例老年晚期非鳞NSCLC患者经培美曲塞为基础的化疗方案治疗后，部分缓解 17例，稳定16例，进展7例，客观有效率（ORR）42.5 %（17／40），疾病控制率（DCR）82.5 %（33／40），中位无进展生存（PFS）5.3个月，1年生存率63.2 %（24／38）。亚组分析A组与B组相比，ORR分别为44.4 %（8／18）、40.9 %（9／22），DCR分别为83.3 %（15／18）、81.8 %（18／22），PFS分别为5.5、5.1个月，1年生存率分别为64.7 %（11／17）、 61.9 %（13／21），前者均高于后者，但差异均无统计学意义（均P＞0.05）。全组患者不良反应较轻，主要为骨髓抑制和胃肠道反应，多为1、2级。结论 在老年患者中，应用以培美曲塞为基础的方案治疗晚期非鳞NSCLC具有良好效果，且不良反应较小，能耐受，可推荐作为体力状况（PS）评分较好的老年晚期非鳞NSCLC的一线化疗方案。

Objective To assess the clinical efficacy and adverse effect of pemetrexed-based chemotherapy as first-line treatment in elderly patients with advanced non-squamous non-small-cell lung cancer （NSCLC）. Methods A total of 40 elderly patients with advanced non-squamous NSCLC confirmed by pathology were retrospective analyzed in the study, who received pemetrexed plus cisplatin （group A, n = 18） or pemetrexed plus carboplatin （group B, n = 22） as the first-line treatment. RECIST was used to assess the efficacy of the treatment and NCI-CTC AE version was used to describe adverse events. Results In the 40 patients, no one received complete response （CR）, 17 patients showed partial response （PR）, 16 had stable disease （SD）, 7 had progress disease （PD）, the objective response rate （ORR） was 42.5 % （17/40） and the disease control rate （DCR） was 82.5 % （33/40）. The median progression-free survival （PFS） time was 5.3 months. 1 year suvival rate was 63.2 % （24/38）. In further subgroup analyses, the ORR, DCR, PFS and 1 year suvival rate in group A were higher than those in group B, but they had no statistically significant difference （P 〉 0.05）. The drug-related adverse events were myelosuppression, gastrointestinal response, most of which were grade 1 to 2. Conclusion Pemetrexed combined with cisplatin or carboplatin may be recommended as first-line chemotherapy for elderly patients with advanced non-squamous NSCLC because of its safety and efficacy.